Catheter device for performing a cholangiogram during a laparoscopy surgery

ABSTRACT

A hand-held instrument for performing a cholangiogram during a laparoscopic surgical procedure is disclosed. The instrument includes a pistol-shaped housing having a cannula mounted at a forward end. Centrally located within the cannula and extending into the housing is a hollow catheter. Mounted within the housing are an advancing mechanism, a locking mechanism, and an injection system. The advancing mechanism incrementally extends the catheter from one end of the cannula and the locking mechanism holds the catheter at the extended position. The injection system expels contrast media from a reservoir within the handle of the housing into the catheter for injection into a cystic duct. Each of the systems within the housing can be independently operated by the hand holding the instrument. The end of the cannula distal from the housing includes a threaded bulge which is rotated by a wheel extending through the housing. Rotation of the wheel screws the threaded bulge into an incision on the cystic duct to facilitate the insertion of the cannula into the duct and to form a watertight seal which prevents leakage at the incision during injection of the contrast media.

FIELD OF THE INVENTION

This invention relates to instruments used in laparoscopic surgery.

BACKGROUND OF THE INVENTION

Laparoscopic surgery is being used more frequently because it is lessintrusive to the patient's body which permits shorter hospital stays.One particular form of surgery which is especially adaptable tolaparoscopic surgery is gall bladder removal.

In a typical laparoscopic surgical procedure for removing a gallbladder, short incisions are made through the abdominal wall of thepatient for the insertion of the surgical instruments used to performthe surgery. The abdominal cavity is bloated by pumping a gas such asCO₂ into the abdominal cavity to provide the surgeons and theirassistants with room to maneuver surgical instruments and a perspectivefrom which a camera inserted into the cavity during the surgery canproperly view the internal organs and abdominal wall. For each incisionmade through the abdominal wall, a trocar is inserted through theincision. The trocar provides a passageway for the surgical instrumentsthrough the patient's skin and abdominal wall and prevents the escape ofthe gas from the cavity during the surgery.

To provide the surgeon with a picture of what is occurring in theabdomen, an incision is made on the patient's umbilicus. After insertionof the trocar, a long laparoscope cylindrical lens of a camera isinserted through the trocar. The camera lens contains a light source toilluminate the organs and the picture generated by the camera isdisplayed on CRTs placed in the vicinity of the patient's upper bodynear the table. After viewing the display generated by the camera, thesurgeon selects an appropriate spot on the upper right abdominal wallwhere a second incision is made and a trocar is inserted. This incisionis used by a second surgeon or surgical assistant to aid the surgeonduring the procedure. A third incision is made on the lower right sidethrough which the second surgeon inserts instruments for assisting inexposing the gall bladder for dissection by the surgeon. The finalincision is made in the upper midline (epigastrium) for the operativeport through which the surgeon inserts various instruments used inperforming the surgery.

To remove the gall bladder, the camera is used to locate adhesions onthe abdominal wall which the surgeon removes with scrapping or cuttinginstruments inserted into the abdominal cavity. The liver is located andlifted to reveal the gall bladder underneath it. The cystic duct whichleads into the gall bladder is clamped at a portion away from the gallbladder. The cystic artery is located and clamped to prevent excessivehemorrhaging in the abdominal cavity should a rupture of this arteryoccur. The gall bladder may be cut or burned loose by a laser. After thehemorrhage sites are cauterized to stop the bleeding, the gall bladderis located and pulled through the operative port in the abdominal wall.The trocars are removed and the incisions sutured. All clips, clamps,and instruments inserted in the abdominal cavity must be accounted bythe surgical nurse.

While such a surgical procedure is effective for the removal of the gallbladder, ductal injuries or anatomical anomalies may not be readilydiscovered during such a surgical procedure. To provide the surgeon withthis information during the surgery, a cholangiogram can be performed. Acholangiogram is an x-ray of the common bile duct which can alert thesurgeon to previously undiscovered stones, anatomical anomalies whichmay require careful dissection, and ductal injuries which may lead tolater complications following the gall bladder removal. If thecholangiogram is performed while the surgery is in process, the surgeonmay remove the stones immediately and reduce the chance ofpost-operation common bile duct obstruction.

To perform a cholangiogram, a pair of micro-scissors are inserted intothe abdominal cavity to dissect the cystic duct at a point between thegall bladder and where it is clamped. The micro-scissors are thenremoved. The surgeon inserts a gripping tool through a trocar while anurse brings a tube leading from a syringe filled with contrast mediainto proximity with the cystic duct. At the forward end of the tube ismounted a cannula with a concentrically located catheter. The surgeongrips the end of the catheter extending from the cannula with thegripping tool and inserts it into the incision made by themicro-scissors. Using the inserted portion of the catheter as a guidewire, a portion of the cannula is inserted into the cystic duct. A clipis placed around the cannula and cystic duct to prevent leakage when thecontrast media is injected.

At this point, all medical personnel except the surgeon and a technicianleave the operating room. The technician places an x-ray film cassetteunder the patient's back and brings a mobile x-ray unit with a flexibleC-arm over the patient's abdomen in the vicinity of the gall bladder.The surgeon then injects the contrast media through the tubing andcatheter into the cystic duct which leads to the gall bladder. As thecontrast media is injected, the technician takes a cholangiogram. Afterthe technician has replaced the cassette with another one, the surgeonbegins another injection so the technician can take a secondcholangiogram. The technician removes the mobile x-ray machine and theother members of the operating team return.

The surgeon removes the clip from around the cannula and grips thecannula to remove it and then the catheter is withdrawn from the cysticduct. The nurse removes the tubing from the patient's abdomen through atrocar and the surgical procedure may proceed. The technician developsthe cholangiograms and returns to the operating room to display them onlight tables in the operating room. The surgeons may view them toascertain if any additional surgical procedures are necessary.

While the information produced from a cholangiogram is important anduseful to surgeons, very few surgeons conducting laparoscopic gallbladder removals regularly take them. This reluctance arises from thedifficulties encountered in performing the procedure for takingcholangiograms. Most of the problems stem from the coordination requiredbetween the surgical team members to grasp and insert the catheter intothe small incision in the cystic duct. This cooperation between teammembers is not only difficult because they must view the CRT tocoordinate their instrument movements within the abdominal cavity, butthey must manipulate articles that are very small. The diameter of thecatheter is smaller than fish line and the incision in the cystic ductis correspondingly tiny. Such a procedure is roughly comparable to twopeople attempting to thread a needle by using barbecue tongs to hold theneedle and thread. In some cases, inserting the catheter into the cysticduct through the small incision may take 30 minutes or longer. Such atime interval almost doubles the time necessary for the removal of agall bladder.

What is needed is an expeditious method for performing a cholangiogramduring a laparoscopic surgical procedure. What are also needed areinstruments with which the surgical personnel can better coordinatetheir interactions to perform the cholangiogram.

SUMMARY OF THE INVENTION

The above problems associated with the taking of a cholangiogram duringa laparoscopic surgical procedure are solved by an instrument built inaccordance with the principles of the present invention. Such aninstrument incorporates structural elements which perform multiplefunctions required for taking a cholangiogram in a single instrument toeliminate the need for coordinating activities between different membersof the surgical team. The advantages of such an instrument include theelimination of using one instrument to perform a single function andthen removing that instrument so it can be replaced by a secondinstrument to accomplish a second function. Another advantage of thepresent invention is to eliminate the number of people needed to performa single activity such as inserting the catheter into the cystic duct.

It is an object of the present invention to provide one instrument fordissecting the cystic duct and inserting the catheter into the duct. Inone embodiment of the present invention, a cannula having a lumenextending from one end to the other is provided with a hollow catheterthat is centrally located within the lumen of the cannula and movablethrough the lumen of the cannula. One end of the cannula is angled withthe edge at the juncture of the cannula and lumen sharpened. The cannulacan be inserted through the trocar and the sharp edge of the cannulaused to create the incision in the cystic duct. Without withdrawing thecannula, the catheter is then advanced into a cystic duct. Followinginsertion of the catheter, the cannula uses the catheter as a guide wireand is pushed into the cystic duct so a clip can be placed around theduct and cannula to seal the incision.

Another object of the present invention is to seal the incision in acystic duct after the cannula has been inserted without requiring aclip. To meet this objective, the cannula has a threaded bulge near theangled end of the cannula. When the cannula is rotated the threadedbulge screws itself into the duct to effectively seal the incision fromleakage. One advantage of this structure is the elimination of thesecond person to insert and place a clip about the cannula as well asthe accounting for the clip within the abdomen.

It is an object of the present invention to provide a non-visualindicator of how far the catheter has been inserted into the cysticduct. One embodiment of the present invention includes an advancingmechanism which pushes the catheter through the cannula while providingacoustic and tactile feedback of the distance the catheter is advanced.One advantage of this device is that the surgeon may keep his eyes onthe visual display without looking at the instrument to determine thecatheter insertion distance.

Another object of the present invention is to selectively lock thecatheter into a fixed relation to the cannula. The embodiment of thepresent invention includes a locking mechanism that secures the catheterafter each increment of its advance so there is no slippage of thecatheter between incremental advancements of the catheter.

Another object of the present invention is to substantiallysimultaneously release the locked relation between the catheter and thecannula while disengaging the catheter from the advancing mechanism. Toaccomplish this objective, a biasing member is provided that isoperatively connected to the catheter and which urges the catheteragainst the advancing mechanism and the locking mechanism. When arelease lever disengages the lock and advancing mechanism, the biasingmember urges one end of the catheter away from the cannula whichretracts the other end into the cannula. One advantage of this mechanismis easy removal of the cannula from the incision that can be performedby one person.

Another object of the present invention is to provide a mechanism forthe person who makes the incision and inserts the catheter and cannulato inject contrast media into the cystic duct through the catheter. Toachieve this objective of the invention, a connector is provided at theend of the catheter away from the cannula. This connector is thenconnected to a contrast media source so the contrast media may flow fromthe source through the connector and into the catheter.

Another object of the present invention is to provide a device forcontrollably pumping a fluid through the catheter. In accordance withthe principles of the present invention, a hand operated plunger andreservoir are operatively connected to the catheter. The plunger islocated so the surgeon controlling the cannula and catheter controls theflow of contrast media from the reservoir to the catheter withoutinterfering with the other functions of the cannula and catheter.

Another object of the present invention is to provide a housing for theadvancing mechanism, the locking mechanism, the release mechanism, andthe pumping mechanism, that is connectable to the cannula and catheterso one person may conduct the cholangiogram procedure. To achieve thisobject, a pistol grip housing is provided in which the cannula ismounted at a forward portion of the housing with the catheter centrallylocated therein and extending through the housing to a connector locatedat the rear of the pistol grip. A trigger is connected to the advancingmechanism mounted in the housing so the surgeon can advance the catheterwith the index finger alone. The advancing mechanism pushes the catheterforwardly through the cannula against the action of a spring mountedabout the catheter within the housing which pushes against a collarconcentrically mounted about the catheter. The locking mechanism engagesthe collar so the trigger activated advancing mechanism may return toits initial position for the next advancement of the catheter. Thecontrast media plunger is operated by the lower three digits of the handon the pistol grip to pump contrast media from a reservoir within thepistol grip handle to a pressure actuated valve connected to thecatheter near the connector to the outside fluid source. When theplunger acts on the reservoir, fluid flows from the reservoir throughthe valve and into the catheter for injection into the cystic duct.

The objects and features of the present invention will become morereadily apparent from the following detailed description taken inconjunction with the accompanying drawings in which:

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of the preferred embodiment of the presentinvention;

FIG. 2 is a fragmentary, cross-sectional view of the preferredembodiment of the invention taken along lines 2--2 of FIG. 1;

FIG. 2A is a partial cross-sectional view taken along lines 2A--2A inFIG. 2;

FIG. 3 is a partial cross-sectional view of the forward portion of thepreferred embodiment of the invention which illustrates the operation ofthe advancing mechanism;

FIG. 4 is a cross-sectional view of the preferred embodiment of theinvention just prior to the injection of the contrast media into thecystic duct during the cholangiogram procedure;

FIG. 5 is a partial cross-sectional view of an alternative embodimentwhich shows a cannula which may be used in an apparatus constructed inaccordance with the principles of the invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

A preferred embodiment of a cholangiogram instrument used for injectingcontrast media into a gall bladder through the cystic duct is shown inFIGS. 1 and 2. The instrument 10 includes a pistol shaped housing 12having forward portion 14, rearward handle portion 16, top surface 17and lower surface 18. Mounted to a dial hub 19 in forward portion 14 isa cannula 20 which contains a catheter 24. Dial wheel 25 of hub 19extends through opening 26 to provide the surgeon with control ofcannula 20 as explained below.

A trigger 27 which controls an advancing mechanism extends below lowersurface 18 while lock and release arm 28 is exposed through top surface17. Also mounted in top surface 17 is a transparent depth gauge 29through which the surgeon can determine the length of catheter 24inserted into duct 30, as explained below. Plunger actuator 31 extendsforwardly of handle 16 for injecting contrast media from a reservoir inhousing 12 through catheter 24 as described in detail below.

Housing 12 is preferably constructed of a resilient, lightweight plasticmaterial so the hand of the surgeon operating the instrument does notfatigue easily. The surface of housing 12 has a finish which provides agood gripping surface for the surgeon through the sterilized, plasticgloves usually worn during surgery. Cannula 20 is mounted at one end toforward portion 14 of housing 12, extends forwardly to a threaded bulge34, and terminates at an angled end 35. A lumen or bore 36 extendsthrough cannula 20 and the edge where lumen 36 and cannula 20 meet atangled end 35 is sharpened. Cannula 20 is preferably constructed fromsurgical stainless steel so the sharpened edge at end 35 retains itscutting edge.

Mounted near the forward portion of housing 12 is the trigger 27 whichis used to drive the advancing mechanism for the catheter 24 which isdescribed in more detail below. Lock and release arm 28, depth gauge 29,and a leur lock 37 are mounted in or through top surface 17 of housing12. Located along lower surface 18 near the rearmost portion of pistolgrip housing 12 is plunger actuator 31. Plunger actuator 31 is connectedby a plunger arm 68 to a plunger 33 mounted within handle portion 16 ofhousing 12. Lock and release arm 28, leur lock 37, plunger 33, andtrigger 27 are all constructed from resilient plastic materials todecrease the weight of the instrument and reduce the cost of itsconstruction.

The internal structure of the preferred embodiment of the presentinvention which accomplishes the multi-functional and compact design ofthe present invention is depicted in FIG. 2. Centrally located withincannula 20 is the hollow catheter 24 which extends through housing 12and forms a loop 38 before connecting with valve 39. Cannula 20 fitssufficiently snug about catheter 24 that no appreciable amount of gasescapes from the abdominal cavity through cannula 20. Cannula 20 isfixedly mounted into dial hub 19 of dial wheel 25. Dial wheel 25 isrotatably secured against front wall 45 by a spring 60.

Catheter 24 is preferably a 4F or 5F size catheter with a preferablelength of 25-30 centimeters, but any length sufficient to extend fromvalve 39 through housing 12 and cannula 20 into the cystic duct 30 byapproximately 1.5-2 centimeters is satisfactory. Loop 38 in catheter 24at its rearward end is preferably provided for storing the extra lengthof catheter needed for extension into the cystic duct 30. The catheter24 is preferably inflexible to prevent kinks or pinching of the catheterwhich may block the flow of fluid through the catheter 24. While thepreferred cannula is approximately 5 mm for an eight centimeter sectionextending from housing 12, then narrows to a diameter of approximately3.5 to 4 mm to threaded bulge 34 and then resumes the reduced diameteron the other side of bulge 34, other dimensions could be used so long asthey maintain a fluid tight seal in the trocar and do not block thesurgeon's view of the duct. The construction of such catheters are wellknown within the art.

Advancing mechanism 48 for extending the catheter beyond sharp end 35 ofcannula 20 includes trigger 27 having a trigger ring 49 and trigger arm53 which is pivotally mounted about pin 51. The distal end 50 of triggerarm 53 is preferably notched, although other connecting methods could beused, to connect one end of driving link 52 to arm 53 while the otherend of link 52 abuts a collar 54. Spring 44 is mounted to housing 12 bya pin 57 at one end and the other end of spring 44 connects to triggerarm 53 through a hole in distal end 50.

Collar 54 is concentrically and fixedly mounted about catheter 24.Collar 54 is cylindrical with regularly spaced apart, circular ridges 58that are concentrically formed about collar 54. Ridges 58 are preferablyspaced approximately 0.2 centimeter apart. Interposed between theforward end of collar 54 and front wall 45 of housing 12 is spring 60which is concentrically mounted about catheter 24. The forwardmost ridgewhich abuts spring 60 has a larger diameter than the other ridgesmounted about collar 54. When trigger 27 is squeezed rearwardly so itclockwise pivots about pin 51 the forward end of link 52 is urgedagainst collar 54 to advance the catheter against the rearward bias ofspring 60.

In the preferred embodiment of the invention, transparent depth gauge 29permits the surgeon to view the top edge of the forward end of collar54. Gauge 29 is inscribed with lines spaced approximately 0.2centimeters apart. As collar 54 is advanced, the juxtaposition of collar54 and the lines on gauge 29 provide a visual indication of how farcatheter 24 has been advanced from cannula end 35. Alternatively, aknown catheter having lineations at its discharge end may be used so thesurgeon can observe the lineations as they enter the incision todetermine the amount of catheter extension.

The internal structure shown in FIGS. 2 and 3 also includes lock andrelease arm 28 which is pivotally mounted about a pin 61. Arm 28 has aforward release member 62 and a rearward locking member 63. End 64 oflocking member 63 generates a downward bias against collar 54 whichurges the locking arm 63 into engagement with collar 54. Release member62 of lock and release arm 28 is laterally offset so it passes outsidethe diameter of the ridge 58 except the forwardmost ridge 65 of thecollar. The lower end of the member 62 extends towards collar 54 frommember 62 to abut the forward end of link 52 along its top edge.

The structural relationships of the ridges on collar 54 with releasemember 62 and link 52 are best shown in FIG. 2A. Link 52 extends acrossa portion of the lowermost circumference of one of the ridges 58.Release member 62 extends downwardly along each side of the collar toabut link 52. The release member is outside of the circumference ofcollar 58 so it does not interfere with the rearward movement of collar54 when the catheter is retracted. Release member 62 is within thecircumference of the forwardmost ridge 65 (shown in phantom) to stop therearward movement of collar 54 during withdrawal of the catheter.

FIG. 2 shows an injection system 66 mounted in the rearward portion ofhousing 12 which includes a plunger actuator 31, reservoir 67 and valve39. Interposed between reservoir 67 and lower surface 18 of housing 12is a plunger 33 that is connected to plunger arm 68. Plunger 33 ishingedly mounted within housing 12 so the plunger lies adjacentreservoir 67 along the entire length of one side. Actuator 31 isconnected to the plunger arm 68 to rotate the plunger againstcollapsible reservoir 67 to force fluid from the reservoir, up throughconduit 69 to valve 39. Valve 39 prevents the fluid from flowing towardsthe leur lock and directs the expelled fluid into the catheter.Reservoir 67 is sufficiently sized to contain approximately 40 cc ofcontrast media since the typical two cholangiogram procedure requirestwo injections of approximately 15 cc of media. The excess capacityprovides a reserve capacity.

To prepare the gall bladder for a cholangiogram, the surgeon insertscannula 20 through one of the trocars and cuts an incision into thecystic duct 30 with the sharp surface of lumen 36 at end 35. Once theincision is made, catheter 24 is advanced through the incision into thecystic duct 30 by squeezing trigger 27.

As trigger 27 is squeezed, trigger arm 53 rotates clockwise about pivot51 against the bias of spring 44 to urge driving link 52 against collar54 (FIG. 3). This urging moves collar 54 forward and advances catheter24 beyond cannula end 35 into the cystic duct 30. In the preferredembodiment of the invention, opening 71 permits lever arm 53 to move adistance which advances collar 54 and catheter 24 by one ridge orapproximately 0.2 centimeter. To prevent catheter 24 from slipping backinto housing 12, locking member 63 engages collar 54 to hold it againstthe rearward bias of spring 60 while trigger 27 is pulled in thecounterclockwise direction by spring 44 for the next incrementaladvance.

The holding action of locking arm 63 is best shown in FIG. 3. As one ofthe ridges 58 pushes locking arm 63 upwardly it also slides underneaththe locking arm as collar 54 moves forward. When ridge 58 of collar 54passes forwardly of locking arm 63, the locking arm falls into a gap 59between adjacent ridges 58. In the preferred embodiment of theinvention, opening 71 through which lever arm 53 extends is sized sothat when lever arm 53 contacts housing 12 at the rearmost portion ofopening 71, one of the ridges 58 have passed forwardly of locking arm63. Releasing trigger 27 permits spring 44 to retract from the extendedposition it reached when arm 53 was pivoted clockwise to rotate trigger27 in a counterclockwise fashion about pivot 51. As arm 53 so rotates,link 52 disengages from collar 54 and the biasing action of spring 60urges collar 54 rearward. This causes the ridge just forward of lockingarm 63 to clockwise rotate lock and release arm 28 about pivot pin 48 tocompress locking arm 63 against housing 12 until locking arm 63 stopsthe rotation. Thus, trigger 27 returns to its forward position whilecollar 54 and catheter 24 remain at the position to which they wereextended without slipping.

If leur lock 37 is connected to an outside fluid source (not shown) suchas saline solution container, the saline solution flows through leurlock 37, valve 39, and catheter 24 to discharge the saline solution fromthe forward end of the catheter. This flow is used to check the flowpath through the catheter into the cystic duct 30. By clockwise rotatingdial wheel 25 in the preferred embodiment, the threads about threadedbulge 39 are advanced, if the threads are a right-hand thread, so thebulge screws itself into the incision. By pushing housing 12 forward,the surgeon causes cannula 20 to follow the inserted catheter like aguide wire so threaded bulge 34 of cannula 20 is inserted into the duct.

Bulge 34 of cannula 20 is sufficiently sized to distend the cystic ductwhen inserted therein and the irregular surface of the threads aregripped by the duct to form a fluid-tight seal between the duct and thethreaded bulge. In the preferred embodiment of the present invention,the threaded bulge has an outside diameter of 3.5 to 4 mm at its maximumwidth and is inscribed with a right-hand thread, though other dimensionsand thread twist directions could be used. The bulge 34 is alsopreferably located within 4 to 12 millimeters of cannula end 35.

An alternative embodiment of cannula 20 is shown in FIG. 5 and isfixedly mounted within bore 76 in housing 12. The bulge 75 of thisembodiment is smooth rather than threaded. The smooth surface of bulge75 may permit fluid to flow over the bulge and leak from the duct at theincision. To prevent this, a clip may be applied to press the ductagainst the bulge to seal the incision.

To inject contrast media into the cystic duct, the surgeon pushesactuator 31 rearwardly towards housing 12 to rotate plunger 33 againstcollapsible reservoir 67 to expel contrast media from the reservoirthrough conduit 69 to valve 39 as shown in FIG. 4. Valve 39 ispreferably a pressure actuated valve that closes the flow from leur lock37 in response to the flow of contrast media from reservoir 67. Thecontrast media flows through catheter 24 into the cystic duct 30. Theconstruction of valve 39 is well known within the art.

The length of plunger arm 68 is sized so an actuator stroke ofapproximately one-half of its length produces a volume of contrast mediasufficient for one cholangiogram. In the preferred embodiment of theinvention, the plunger arm is approximately 4 inches long so a two inchstroke generates a media injection of approximately 10-15 cc. Thesurgeon holds the actuator at the half way point while the technicianchanges film for the second cholangiogram and then pushes the actuatoruntil it contacts lower surface 18 to provide the media injection forthe second x-ray.

After the cholangiograms are taken, the catheter may be removed from thecystic duct by pushing release arm 28. As shown in FIG. 4, collar 54 isadvanced to a position where catheter 24 is extended from cannula 20 byapproximately 4 centimeters. The surgeon may now depress lock andrelease arm 28 with sufficient pressure to clockwise rotate the armabout pivot point 61 which compresses locking arm 63 against housing 12.The surgeon can easily exert enough pressure against resilient lockingarm 63 so the locking arm clears ridges 58. As this happens, theinwardly extending end of release member 62 pushes against the top edgeof driving link 52 to drive link 52 vertically downward and disengage itfrom collar 54. Because the laterally offset portion of member 62 liesoutside the diameter of ridge 58, the collar is urged rearwardly byspring 60 to retract catheter 24 into cannula 20. The rearward movementof collar 54 caused by spring 60 is halted when the laterally offsetposition of member 62 contacts forwardmost ridge 58. When link arm 28 isreleased, locking member 63 rotates counterclockwise to re-engage collar54. Cannula 20 may then be removed from the abdominal cavity and trocar.

The instrument shown in FIG. 1 provides a surgical instrument that fitseasily in the grasp of a human hand. All aspects of the procedurenecessary to perform a cholangiogram--cutting the cystic duct, insertingthe cannula and catheter into the duct, pumping contrast media into theduct and removing the cannula from the duct--can be performedsinglehandedly by a surgeon with this instrument. The controls for thevarious functions of the instrument are conveniently located forindependent control by different fingers of the surgeon's hand. Forexample, trigger 27 is squeezed typically by the index digit of the handto advance the catheter through the cannula. Actuator 31 can be pushedrearwardly towards housing 12 to expel contrast media from reservoir 67into the catheter by the last three fingers. When the cholangiogram hasbeen taken, the thumb may be used to push lock and release arm 28 sospring 60 withdraws the catheter into cannula 20. The incorporation ofall of the functions necessary to perform a cholangiogram into a singleinstrument and conveniently locating all the controls for the functionsso they may be operated independently by the fingers of the surgeon'shand is an important advantage of the present invention.

Each full squeeze of trigger 27 advances a predetermined length ofcatheter 24 from cannula 20 when catheter 24 is initially aligned withthe sharpened opening of the lumen at angled end 35. The tactilefeedback provided from the trigger squeeze permits the surgeon to counteach squeeze to know the depth of catheter insertion without removinghis eyes from the CRT. Additionally, the locking mechanism produces anaudible click as collar 54 is halted and as trigger 27 returns to itsforward position. This click provides auditory confirmation of thetrigger squeeze count. Should the surgeon inadvertently lose count ofthe clicks and trigger pulls, the visual window can be checked to seehow far the catheter is extended.

While the present invention has been illustrated by the description of apreferred embodiment and while the embodiment has been described inconsiderable detail, it is not the intention of the applicant to berestricted or any way limit the scope of the appended claims to suchdetail. Additional advantages and modifications will be readily apparentto those skilled in the art. The invention in its broader aspects istherefore not limited to the specific details, representative apparatusand method, and illustrative examples shown and described. Accordinglydeparture may be made from such details without departing from thespirit or scope of applicant's general inventive concept.

What is claimed is:
 1. A device for performing a cholangiogram during alaparoscopic surgical procedure comprising:a cannula having a lumenextending between first and second ends, said first end of said cannulahaving a sharpened edge at he juncture of said cannula and said lumen; athreaded bulge proximate said first end of said cannula; and a hollowcatheter having first and second ends and being concentrically locatedand slidable within said lumen of said cannula, said first end of saidcatheter being within said cannula and said second end extending fromsaid second end of said cannula whereby said sharpened edge of saidcannula may be used to cut an incision into a cystic duct and saidthreaded bulge facilitates the insertion of the cannula into the cysticduct to form a seal so the catheter may be slid towards said first endand through the incision into the cystic duct.
 2. The device of claim 1further comprising:means for advancing said catheter within said cannulato extend said first end of said catheter beyond said first end of saidcannula.
 3. The device of claim 2 further comprising:means for lockingsaid catheter in fixed relation to said cannula.
 4. The device of claim2 further comprising:means for determining the distance said first endof said catheter is extended beyond said first end of said cannulawhereby a surgeon advancing said catheter by said advancing means knowswhen said catheter is extended a predetermined distance from said firstend of said cannula.
 5. The device of claim 2 further comprising:meansfor selectively connecting said catheter to one of two fluid sourceswhereby said catheter may be used to inject either one of the two fluidscontained within the fluid sources.
 6. The device of claim 1 furthercomprising:a dial having a hub connected to a wheel, said second end ofsaid cannula being mounted within said hub whereby rotating said wheelof said dial rotates said hub and said cannula to advance said threadedbulge into the incision.
 7. A method for performing cholangiogram duringa laparoscopic surgical procedure comprising the steps of:opening acystic duct with a sharpened edge at a juncture of a lumen within acannula at one end of the cannula; advancing a hollow catheter,concentrically located within the cannula, through the opening in thecystic duct into the cystic duct; inserting the end of the cannula and athreaded bulge of the cannula proximate the inserted end into the cysticduct to substantially stop the flow of fluids through the opening of thecystic duct about the cannula; rotating the cannula to advance thethreaded bulge on the cannula proximate the inserted end to facilitatethe insertion of the cannula and threaded bulge; injecting contrastmedia into the cystic duct through the hollow catheter; radiographicallytaking a cholangiogram; and retracting the catheter and cannula from thecystic duct.
 8. A hand held apparatus for performing a cholangiogramduring a laparoscopic surgical procedure comprising:a housing shaped andsized to fit a human hand, said housing having a forward and a rearwardportion; a cannula having a lumen extending between first and secondends, said first end being mounted to said forward portion of saidhousing and said second end extending away from said housing, saidsecond end of said cannula having a sharpened edge at the juncture ofsaid lumen and said second end of said cannula, said second end having abulge proximate said sharpened edge; a hollow catheter having first andsecond ends, said catheter being concentrically located within saidcannula with said first end of said catheter proximate said second endof said cannula and said second end of said catheter extending throughsaid housing and extending from said rearward portion of said housing.9. The device of claim 8 wherein said bulge is threaded whereby turningsaid cannula screws said second end and said bulge of said cannula intothe incision.
 10. The device of claim 8 further comprising:a dialrotatably mounted within said housing, said dial having a wheelconnected to a hub, said first end of said cannula being mounted withinsaid hub whereby turning said wheel of said dial rotates said cannula toscrew said second end and said bulge into the incision to prevent fluidsfrom leaking from the incision.
 11. The device of claim 8 furthercomprising:means for advancing said catheter within said cannula toextend said first end of said catheter from said second end of saidcannula.
 12. The device of claim 11 further comprising:means for viewinga portion of said catheter advancing means, said viewing means beingmounted in said housing near said forward portion, said viewing meansbeing lineated whereby the juxtaposition of said portion of saidcatheter advancing means viewed through said viewing means with saidlineation of said viewing means may be used to determine how far saidcatheter has been extended from said second end of said cannula.
 13. Thedevice of claim 8 further comprising:means for selecting fluid from oneof two fluid sources for injection through said catheter, said selectingmeans being operatively connected to said second end of said catheter; areservoir for holding one of the two fluid sources, said reservoir beingoperatively connected to said selecting means; and means for expellingthe fluid in said reservoir through said selecting means and saidcatheter, said expelling means being mounted to said housing andoperatively connected to said reservoir.
 14. The device of claim 13wherein said reservoir is collapsible and said expelling means furthercomprises:plunger means hingedly mounted to said housing and lyingadjacent at least one side of said reservoir; and actuating meansconnected to said plunger means and extending from said housing wherebysaid actuating means may be pressed to urge said plunger means againstsaid collapsible reservoir to expel the fluid from said reservoir. 15.The device of claim 11 wherein said expelling means and said advancingmeans are located on said housing so that said expelling means and saidadvancing means may be independently operated by different digits of onehand.